The Gift of Study

Introduction

Many who read this blog will begin their studies of medicine in a few short weeks while others will move into new roles perhaps with more responsibility and duties. I wanted to take a few lines to write about moving into your new roles be they medical student, intern (PGY-1), resident or attending physician.

Preparation

A mentor from my first days of medical school, actually during orientation, said in his soft southern accent, “Now go out and grab a copy of The New England Journal of Medicine and read it from cover to cover.” “You won’t understand it at first but keep reading it and studying the words of medicine.” Little did he know that he had just added more fodder to my constant journal reading and now had stoked a fire so huge that I could have been consumed in the flames, so to speak. As I look back now, years from those words and others that have shaped my current practice. Listen to those little bits and pieces of wisdom from people who will enter your medical education early on.

For those of you who will begin the study of medicine, your preparation is to open your mind, your ears and to consider the privilege of what you are to undertake. Yes, you will be “sipping from that fire hose of facts and materials” to be mastered but you have been given the gift of being able to study those facts and materials. You may want to allow yourself from time to time to marvel in what you will learn from the application of science to the practice of medicine. In short, take a moment to breath and enjoy the process.

For those who move “up in rank”, take a moment to look back on the things that you have studied. Every time one encounters a familiar concept, there will be new insight. For example, my intern year was spent learning the craft of patient care preoperative, intraoperatively and postoperative. As the weeks went by, I became expert, perhaps efficient in being able handling patient admissions to the hospital post-surgery, from the emergency department or from the clinic. Additionally, I learned to anticipate and manage the needs of those inpatients from their first moments under my care to their discharge from my care. My insight at this point was how my studies of symptoms and signs coupled with science now allowed me to care for my patients and see how amazing the human body and human spirit can be.

On my first rotation, as my learning curve was steepest, I felt as overwhelmed as I felt in my first week of medical school when biochemistry, anatomy and microbiology came flooding at me in torrents. At this point, it seemed that the work of history and physical exam with admission orders, checking tests/studies, checking wounds and discharge summaries would consume me but one week in, I was thriving and looking for every chance to get into the operating room in addition to my ward duties. I could take that moment to appreciate interaction with patients, nursing staff and get to scrub surgical cases. I was “basking in the glow of bright lights while playing with cold steel, “as one of my professors would say.

When I look back, one of my gifts on those first rotations was being assigned as the intern to the chief resident that everyone had whispered being the most difficult in our ranks. I came to appreciate my chief, the only person that I know who is as compulsive and anal as myself when it comes to the practice of surgery, is that I actually found that I could “get down there and nail things” faster than he could after three weeks. He made me stronger, faster, more efficient and more comprehensive. This allowed more time for me to obtain operating time which is why I became a surgeon in the first place. What other surgery interns avoided, I happily sought out. I was also the recipient of more valuable study advice from my chief, “Force yourself to read at least 30 minutes every day, more if you can, and at least 2 hours on the weekends.” There again is that gift of study. I stuffed my pockets with articles, pages from my textbooks and the surgical atlas. Even if I was exhausted, I had something to read or study in the back pocket of my scrub pants.

Performance

Back to my professor of surgical critical care: “Surgeons are not made, they are forged” was one of his favorite quotes to me. I thrived in the forge of residency because I didn’t look at study and learning while performing medical/surgical care as being in some sort of purgatory or prison. I was getting the opportunity to build a solid foundation of knowledge and skill that I would use for the rest of my life. I learned through being forged that I could solve problems and touch a multitude of fellow human beings in ways that others would never appreciate.

My professor would later say at my graduation that I never complained or said that I was tired when he knew that I was the oldest resident in the ranks. (I had attended medical school after graduate school). He said that he found that somewhat remarkable because as he had aged, he felt entitled to complain more and accept less mediocrity. He said that I was a person who accepted everyone as I found them without agenda. (Still one of the most interesting comments that I have heard about myself).

Under the scrutiny of my mentor in residency who like my first chief, was known for having a very challenging personality, read malignant here, I learned the clarity and performance of surgical skill. My mentor (faculty adviser), taught me to waste no movement in honing surgical skills. He loved that I studied as I learned and assimilated what I was taught in craft and theory. Again, back to those study skills.

Little did he know, I cut the spines from my surgical texts, punched holes in the pages so the they would fit in a ring and were more portable than the entire text (Sabiston’s Textbook of Surgery). My best memories of my faculty adviser are of him folded in a lounge chair in the surgical lounge with his Danskos next to his feet grilling me on how to handle this complication and what would happen next as this was more valuable than gold for me.

Even today, the residents, medical students and physician assistant students appreciate my high expectations of them in terms of work and study. I do not subscribe to the practice of berating as a means of teaching but go back to my very tough first chief resident and my faculty mentor in residency who generously gave of themselves to guide me towards performance at the highest level. I don’t have the difficult personality traits that were characteristic of many of my fellow surgeons but I have high expectations of those who have been assigned to me for instruction.

Practice

The gift of the study, and later practice, of medicine (if you are fortunate) is still one of the most divinely mystical and satisfying acts of a lifetime. Even if you are beginning your studies and are not enjoying much patient interaction, try to cultivate a love and appreciation for the gift of study. Those studies will allow mental efficiency which can lead to some of the most intimate and spiritual gifts from one human to another. Appreciate those gifts without complaint because many others will never have the privilege of enjoying them as you have them now.

Thank you very much for posting this. I will be applying to medical school this year (also as an older applicant, 34 years old) so I enjoy reading the experiences of others who have been before me. I liked your references to the art of studying, having a good attitude, learning from those more senior and of course patient interaction. I love studying, learning science and working with people so I am looking forward to embarking on this journey through medical school despite the long, challenging road ahead. Your post has made me even more enthusiastic to launch into medicine. Thank you!

Thank you very much for the useful advice! I’m applying to medical school this year (also as an older applicant, 34 years old) so I enjoy reading the experiences of others who have been before me. I liked your references to the art of studying, having a good attitude, learning from those more senior and of course patient interactions. I love studying, learning science and working with people and I really look forward to embarking on the journey through medical school, even though I know it’s a long, challenging road. Thank you again! Your post has made me even more enthusiastic!